Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

OUTPATIENT EAPG 00365: LEVEL II ENDODONTICS

Facility OP

$1,192.00

Service Code	EAPG 00365
Hospital Charge Code	EAPG 00365
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00366: LEVEL III ENDODONTICS

Facility OP

$1,192.00

Service Code	EAPG 00366
Hospital Charge Code	EAPG 00366
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00367: LEVEL I ORAL AND MAXILLOFACIAL SURGERY

Facility OP

$1,192.00

Service Code	EAPG 00367
Hospital Charge Code	EAPG 00367
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00368: LEVEL II ORAL AND MAXILLOFACIAL SURGERY

Facility OP

$1,192.00

Service Code	EAPG 00368
Hospital Charge Code	EAPG 00368
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00369: LEVEL III ORAL AND MAXILLOFACIAL SURGERY

Facility OP

$1,192.00

Service Code	EAPG 00369
Hospital Charge Code	EAPG 00369
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00370: LEVEL IV ORAL AND MAXILLOFACIAL SURGERY

Facility OP

$1,192.00

Service Code	EAPG 00370
Hospital Charge Code	EAPG 00370
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00371: LEVEL I ORTHODONTICS

Facility OP

$1,192.00

Service Code	EAPG 00371
Hospital Charge Code	EAPG 00371
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00372: SEALANT

Facility OP

$1,192.00

Service Code	EAPG 00372
Hospital Charge Code	EAPG 00372
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00373: LEVEL I DENTAL FILM

Facility OP

$7.89

Service Code	EAPG 00373
Hospital Charge Code	EAPG 00373
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$7.89
Rate for Payer: Buckeye Health Medicaid OOS	$7.89
Rate for Payer: Molina Healthcare of OH Medicare	$7.89

OUTPATIENT EAPG 00374: LEVEL II DENTAL FILM

Facility OP

$14.65

Service Code	EAPG 00374
Hospital Charge Code	EAPG 00374
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$14.65
Rate for Payer: Buckeye Health Medicaid OOS	$14.65
Rate for Payer: Molina Healthcare of OH Medicare	$14.65

OUTPATIENT EAPG 00375: DENTAL ANESTHESIA

Facility OP

$14.33

Service Code	EAPG 00375
Hospital Charge Code	EAPG 00375
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$14.33
Rate for Payer: Buckeye Health Medicaid OOS	$14.33
Rate for Payer: Molina Healthcare of OH Medicare	$14.33

OUTPATIENT EAPG 00376: DIAGNOSTIC DENTAL PROCEDURES

Facility OP

$21.33

Service Code	EAPG 00376
Hospital Charge Code	EAPG 00376
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$21.33
Rate for Payer: Buckeye Health Medicaid OOS	$21.33
Rate for Payer: Molina Healthcare of OH Medicare	$21.33

OUTPATIENT EAPG 00377: PREVENTIVE DENTAL PROCEDURES

Facility OP

$39.32

Service Code	EAPG 00377
Hospital Charge Code	EAPG 00377
Min. Negotiated Rate	$39.32
Max. Negotiated Rate	$39.32
Rate for Payer: Buckeye Health Medicaid OOS	$39.32
Rate for Payer: Molina Healthcare of OH Medicare	$39.32

OUTPATIENT EAPG 00378: LEVEL II PERIODONTICS

Facility OP

$1,192.00

Service Code	EAPG 00378
Hospital Charge Code	EAPG 00378
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00379: LEVEL II ORTHODONTICS

Facility OP

$1,192.00

Service Code	EAPG 00379
Hospital Charge Code	EAPG 00379
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00380: ANESTHESIA

Facility OP

$176.65

Service Code	EAPG 00380
Hospital Charge Code	EAPG 00380
Min. Negotiated Rate	$176.65
Max. Negotiated Rate	$176.65
Rate for Payer: Buckeye Health Medicaid OOS	$176.65
Rate for Payer: Molina Healthcare of OH Medicare	$176.65

OUTPATIENT EAPG 00381: LEVEL I DENTAL IMPLANTS

Facility OP

$1,192.00

Service Code	EAPG 00381
Hospital Charge Code	EAPG 00381
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00382: LEVEL II DENTAL IMPLANTS

Facility OP

$1,192.00

Service Code	EAPG 00382
Hospital Charge Code	EAPG 00382
Min. Negotiated Rate	$1,192.00
Max. Negotiated Rate	$1,192.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,192.00
Rate for Payer: Molina Healthcare of OH Medicare	$1,192.00

OUTPATIENT EAPG 00384: LEVEL III CHEMISTRY TESTS

Facility OP

$33.94

Service Code	EAPG 00384
Hospital Charge Code	EAPG 00384
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$33.94
Rate for Payer: Buckeye Health Medicaid OOS	$33.94
Rate for Payer: Molina Healthcare of OH Medicare	$33.94

OUTPATIENT EAPG 00385: LEVEL I MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility OP

$98.18

Service Code	EAPG 00385
Hospital Charge Code	EAPG 00385
Min. Negotiated Rate	$98.18
Max. Negotiated Rate	$98.18
Rate for Payer: Buckeye Health Medicaid OOS	$98.18
Rate for Payer: Molina Healthcare of OH Medicare	$98.18

OUTPATIENT EAPG 00386: LEVEL II MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility OP

$135.81

Service Code	EAPG 00386
Hospital Charge Code	EAPG 00386
Min. Negotiated Rate	$135.81
Max. Negotiated Rate	$135.81
Rate for Payer: Buckeye Health Medicaid OOS	$135.81
Rate for Payer: Molina Healthcare of OH Medicare	$135.81

OUTPATIENT EAPG 00387: LEVEL III MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility OP

$207.07

Service Code	EAPG 00387
Hospital Charge Code	EAPG 00387
Min. Negotiated Rate	$207.07
Max. Negotiated Rate	$207.07
Rate for Payer: Buckeye Health Medicaid OOS	$207.07
Rate for Payer: Molina Healthcare of OH Medicare	$207.07

OUTPATIENT EAPG 00388: LEVEL III MICROBIOLOGY TESTS

Facility OP

$104.42

Service Code	EAPG 00388
Hospital Charge Code	EAPG 00388
Min. Negotiated Rate	$104.42
Max. Negotiated Rate	$104.42
Rate for Payer: Buckeye Health Medicaid OOS	$104.42
Rate for Payer: Molina Healthcare of OH Medicare	$104.42

OUTPATIENT EAPG 00389: LEVEL II CONVENTIONAL RADIOLOGY

Facility OP

$109.12

Service Code	EAPG 00389
Hospital Charge Code	EAPG 00389
Min. Negotiated Rate	$109.12
Max. Negotiated Rate	$109.12
Rate for Payer: Buckeye Health Medicaid OOS	$109.12
Rate for Payer: Molina Healthcare of OH Medicare	$109.12

OUTPATIENT EAPG 00390: LEVEL I PATHOLOGY

Facility OP

$15.89

Service Code	EAPG 00390
Hospital Charge Code	EAPG 00390
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$15.89
Rate for Payer: Buckeye Health Medicaid OOS	$15.89
Rate for Payer: Molina Healthcare of OH Medicare	$15.89

Price Transparency.

All Charges